Summary of findings for the main comparison. Midwife‐led compared with other models of care for childbearing women and their infants (all) for childbearing women.
| Midwife‐led compared with other models of care for childbearing women and their infants (all) for childbearing women | ||||||
| Patient or population: Pregnant women Settings: Australia, Canada, Ireleand, UK Intervention: Midwife‐led models of care Comparison: All other models of care for childbearing women and their infants | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| other models of care for childbearing women and their infants (all) | Midwife‐led | |||||
| Preterm birth (less than 37 weeks) | Study population | RR 0.76 (0.64 to 0.91) | 13238 (8 RCTs) | ⊕⊕⊕⊕ HIGH | None of the included trials in this review had adequate blinding. We have not downgraded evidence (‐1) for risk of bias due to lack of blinding. | |
| 63 per 1000 | 48 per 1000 (41 to 58) | |||||
| Moderate | ||||||
| 59 per 1000 | 45 per 1000 (38 to 54) | |||||
| All fetal loss before and after 24 weeks plus neonatal death | Study population | RR 0.84 (0.71 to 0.99) | 17561 (13 RCTs) | ⊕⊕⊕⊕ High | ||
| 34 per 1000 | 29 per 1000 (24 to 34) | |||||
| Moderate | ||||||
| 20 per 1000 | 17 per 1000 (14 to 20) | |||||
| Spontaneous vaginal birth (as defined by trial authors) | Study population | RR 1.05 (1.03 to 1.07) | 16687 (12 RCTs) | ⊕⊕⊕⊕ HIGH | ||
| 658 per 1000 | 691 per 1000 (677 to 704) | |||||
| Moderate | ||||||
| 693 per 1000 | 727 per 1000 (713 to 741) | |||||
| Caesarean birth | Study population | RR 0.92 (0.84 to 1.00) | 17674 (14 RCTs) | ⊕⊕⊕⊕ HIGH | ||
| 155 per 1000 | 143 per 1000 (130 to 155) | |||||
| Moderate | ||||||
| 156 per 1000 | 144 per 1000 (131 to 156) | |||||
| Instrumental vaginal birth (forceps/vacuum) | Study population | RR 0.90 (0.83 to 0.97) | 17501 (13 RCTs) | ⊕⊕⊕⊕ HIGH | ||
| 143 per 1000 | 129 per 1000 (119 to 139) | |||||
| Moderate | ||||||
| 179 per 1000 | 161 per 1000 (149 to 174) | |||||
| Intact perineum | Study population | RR 1.04 (0.95 to 1.13) | 13186 (10 RCTs) | ⊕⊕⊕⊕ HIGH 1 | ||
| 269 per 1000 | 279 per 1000 (255 to 304) | |||||
| Moderate | ||||||
| 333 per 1000 | 346 per 1000 (316 to 376) | |||||
| Regional analgesia (epidural/spinal) | Study population | RR 0.85 (0.78 to 0.92) | 17674 (14 RCTs) | ⊕⊕⊕⊕ HIGH 2 | ||
| 270 per 1000 | 229 per 1000 (211 to 248) | |||||
| Moderate | ||||||
| 287 per 1000 | 244 per 1000 (224 to 264) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Statistical heterogeneity, I² = 54%. We did not downgrade the evidence for heterogeneity with I2 < 60%.
2Statistical heterogeneity, I² = 57%.